427 - Use of Haloperidol For the Management of Cannabinoid Hyperemesis Syndrome: Comparing Pediatric and Adult Patient Characteristics

Publication Number: 4418.427

Didier A. Murillo Parra, The Children's Hospital at Montefiore, Bronx, NY, United States; Jonathan Friedman, The Children's Hospital at Montefiore, Bronx, NY, United States; Prannoy Kaushal, The Children's Hospital at Montefiore, Bronx, NY, United States; Daniel M. Fein, The Children's Hospital at Montefiore, Teaneck, NJ, United States

Background: Cannabinoid Hyperemesis Syndrome (CHS) causes cyclical nausea, vomiting, and abdominal pain in heavy cannabis users and is often refractory to standard antiemetics. While haloperidol has demonstrated good efficacy in adults, data on its pediatric use remains limited.

Objective: To compare the frequency of haloperidol use for CHS between pediatric and adult patients in the Emergency Department (ED), and to evaluate differences in management between Pediatric Emergency Medicine (PEM) and Emergency Medicine (EM) providers.

Design/Methods: This was a retrospective cohort study of patients presenting to EDs of a large urban healthcare system from January 2021-July 2025. Subjects were included if they had symptoms of CHS and an ICD-10 code for marijuana use. Exclusion criteria were pregnancy, chronic medical problems that may mimic symptoms of CHS, or a more likely alternate diagnosis. We compared ED testing and management between pediatric (>10−20 years) and adult (>21 years) subjects. A cutoff of 21 years was chosen as it is the institutional definition of pediatrics. Only the first visit with CHS symptoms was included for each subject. A sample size calculation of 58 patients in each arm was determined to detect a 50% difference in haloperidol use between groups. Outcomes included haloperidol use, adjunctive medication use, laboratory/imaging studies, ED length of stay (LOS), and disposition.

Results: A total of 116 subjects (58 pediatric, 58 adult) were included, with a median age of 19 [IQR 2] vs. 28 [IQR 10] years, (p < 0.001). More females were in the pediatric group (65.5% vs. 41.4%, p=0.015). Overall, most patients were treated by EM providers (77.6% vs. 22.4%, p= < 0.001) [Table 1]. Only 47.4% of patients received haloperidol and there was no difference between age groups (p=0.265) or provider type (p=0.826). Similarly, there was no difference in ED LOS (p=0.930), or disposition (p=0.462) [Table 2]. PEM providers used acetaminophen (23.1% vs. 4.4%, p=0.008) and ondansetron (88.5% vs. 66.7%, p=0.046) more often, while EM providers used metoclopramide more (35.6% vs. 11.5%, p=0.027). Adults received diphenhydramine more often (31.0% vs. 10.3%, p=0.011) and had more CT scans (19.0% vs. 5.2%, p=0.043), both exclusively ordered by EM providers [Table 3].

Conclusion(s): Haloperidol is infrequently utilized for CHS in the ED, regardless of patient age or provider type. Differences exist in adjunctive medication and imaging practices, with EM providers ordering more CT scans. Further investigation is necessary to establish optimal, evidence-based CHS treatment protocols.

TABLE 1. Patient Characteristics


TABLE 2. Treatment and Clinical Characteristics


TABLE 3. Adjunctive medications and ancillary studies